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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 15 Telephone Hearing Requests An oral request for a hearing made by telephone must be documented in written form by staff handling the call. The specialist will complete the appropriate hearing request form, i.e., DOM 350, Request for Local Hearing, or DOM 352, Request for State Hearing, and sign the form to begin the appeal process via the telephone request. Written Hearing Requests When a written request is received, the specialist or supervisor will complete the DOM 350 Request for Local Hearing or DOM 352 Request for State Hearing and sign the form to begin the appeal process. Any written request received from the client will be attached to the DOM 350 or DOM 352. The request may be submitted to the regional or central office by mail, in-person or by fax or by electronic means. An original signature is not required to be a valid hearing request. If the hearing request does not specify the type of hearing desired, the specialist will contact the person making the request to determine whether a local or a state hearing is being requested. If contact cannot be made within three (3) days of receipt of the hearing request, the regional office will assume a local standard hearing is requested and schedule accordingly. However, if the hearing involves a medical decision, which requires that a state hearing be held or if a state hearing is requested, the request will be forwarded to the Office of Administrative Appeals in the Central Office for assignment to a hearing officer. Hearing Requests Made in Person The individual may come to the regional office or meet with a specialist in person to request a hearing. The specialist must first determine what level of hearing, local or state, is desired. If a state level hearing is required because the hearing request is based on a medical decision, this will be explained to the individual. Otherwise, if the individual is unsure of the type hearing desired, the specialist will explain the difference between the two levels of appeal and types of hearings, standard or expedited and explain a state hearing may still be available if the local hearing decision is not favorable. The specialist will assist the individual in completing the appropriate form, DOM-350 or DOM 352, whichever is applicable. If a state hearing is required or Effective Month: July 2025